What’s a Health Care Surrogate? Definition, Role + Forms


Certified Care Manager, Aging Life Care Professional, and National Master Guardian Emeritus

Life seems to get more and more complicated, and that is especially true when you get older. In preparation for unforeseen events, you need to plan—regardless of your age. Most people wait to do end-of-life planning when they start to become ill or lose physical or mental capacity.

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However, the reality is that anything can happen to anyone at any time. It is hard to think about a tragedy or event that might render you unable to make decisions for yourself, but it happens to people every day. 

The solution to the potential problem of not advocating for yourself is to assign that duty to someone else in advance. That is why health care surrogacy is considered part of advance directive planning. The complicating factor is that every state uses a different term to describe virtually the same thing. We will sort all of this out for you, but make sure you check with your state’s requirements and terms before choosing a health care surrogate.

Definition of a Health Care Surrogate

A health care surrogate form is a legal document that appoints a person to become your substitute decision-maker if you become incapacitated. You could become incapacitated due to several different circumstances or conditions, some temporary and others permanent.

The health surrogate document gives your surrogate legal authority to talk to your doctors, manage your medical care, and even make medical decisions for you if you cannot do so. In some states, a health care surrogate can assist with decision-making and advocating even if you are not incapacitated. 

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Cognitive impairment

Alzheimer’s disease, Lewy body dementia, and other forms of dementia can eventually contribute to an inability to make reasonable and safe decisions. Most people also designate a financial power of attorney in addition to a health care surrogate to handle bill paying and protect someone from exploitation. When someone gets to the point where they can no longer manage their health care and communicate with providers, the health care surrogate can step in.

Mental illness

Most people can manage mental illness with a combination of medications and therapy. Complicated mental health issues like schizophrenia, bipolar disorder, and other psychotic illnesses sometimes become so severe that the person cannot make safe decisions. 

Intellectual and developmental disabilities

Conditions such as autism, Down syndrome, and others are well-managed by many people. But for others, these conditions can make it challenging to manage their day-to-day lives. A health care surrogate can assist the individual with critical health care decisions.


Obviously, if someone is unconscious, they can’t make their wishes known. Accidents, heart attacks, surgeries requiring anesthesia are all situations where a person is unconscious. Decisions like CPR and feeding and breathing tubes would be up to your health care surrogate who follows your advance directives to the extent that they can.

What’s the Difference Between a Health Care Surrogate, Health Care Proxy, and Medical Power of Attorney?

The terms health care surrogate, health care proxy, and medical power of attorney are all used interchangeably. For example, in Texas, the form is called “Medical Power of Attorney Designated Healthcare Agent.” In Virginia, the term is “Advance Directive for Healthcare.” They are all health care surrogate forms with different names but the same purpose.

On occasion, the court will appoint a “health care surrogate” for someone who has no one to perform that duty for them. This process usually involves the designation of a court-appointed guardian to assume health care surrogacy duties. In many cases, if a family member is not available or willing, the health care surrogate could be a professional company.

What Duties Does a Health Care Surrogate Typically Perform?

The duties a health care surrogate typically performs are dependent on the situation and the authority provided to the surrogate by the person. Suppose you have the authority to make decisions regardless of capacity. In that case, you can obtain health care information, talk to providers and help with decisions, but in the end, your loved one is in control.

Decide medical and surgical treatments

Medical and surgical treatments could be any interventions that the designee has indicated that they want. But, the fact is you can’t predict all situations and circumstances, and that is why you pick someone you trust to do what you would when the time comes.

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End-of-life decisions and procedures

End-of-life decisions are complex and emotional. Do you want CPR if you are unlikely to recover your previous level of functioning? Are you willing to have a feeding tube or artificial breathing? Under what specific conditions would you allow these interventions? Your health care surrogate is responsible for carrying out these wishes.

Where medical treatment is received

You may have a preferred medical system, and you can designate that on your health care surrogacy form. However, your surrogate has the ability to override that if they feel the situation dictates another location.

Release of medical records

As the health care surrogate you can request medical records and authorize their release to other family members and health care providers. As the health care surrogate, you can speak with health care providers about the person’s condition and get advice and counsel on treatment options.

Communicate with others

As the health care surrogate, it is as if you stand in the shoes of the person who selected you. You can communicate a person’s health care condition, prognosis, or anything else you feel is relevant to family members and friends.

Organ donation

Most people determine whether they want to donate their organs and state so on an advance directive form. If they have not made that determination as the health care surrogate, you can decide upon the person’s death.

What States Allow You to Use a Health Care Surrogate?

Every state in the U.S. allows you to use a health care surrogate, but the forms and conditions will differ. Some states require two witnesses, some require the form to be notarized, some exclude the designation of a health care surrogate if you are pregnant, and a few have no formal requirements at all.

What Forms Do You Need to Designate a Health Care Surrogate?

Any form to designate a health care surrogate must be the one approved by the state where you live. Documents can vary from state to state but at a minimum, some ask for your designated health care surrogate name and their contact information.

Other forms will require information related to the limits of that authority. They may also include the nomination of a guardian (who could be someone other than your health care surrogate) to consent to participate in medical research, obtaining medical records, and specifics regarding health care and end of life treatment. 

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How to Designate a Health Care Surrogate

Now that you have a better understanding of your health care surrogate’s scope of responsibilities, you can see how vital it is that you take the time to pick the right person. Also, your situation and relationship with your designated health care surrogate could change over time, and you have the right to change to another person at any time.

1. Make a list of potential candidates

Most people choose their spouse or partner as their health care surrogate. But, consider their health and ability to perform those duties and take on that responsibility. For each potential candidate, make a pros and cons list. Think about the person you trust to make the most crucial decisions regarding your care.

2. Obtain a copy of the legal health care surrogate form

Since every state has its own form with differing questions, it is essential to know what you ask a health care surrogate to do. Reviewing the form begins your careful thinking about how and under what circumstances you want interventions. The more detailed the health care surrogacy form, the more control you have over decisions. Some forms even allow you to write in special instructions. 

3. Talk to potential candidates about the responsibilities

Anyone who is asked to be a health care surrogate has the right to be completely informed about what that means. The commitment and responsibility can be immense and time-consuming, so it is important to have honest discussions about what could be involved. The person you have in mind may decline, so respectfully accept their reasons for refusal. Move on to the next person you have in mind.

4. Sign the forms with your designated health care surrogate

Every state has specific requirements to make your health care surrogate form legal. If witnesses are required, then contact friends or ask if your bank has a notary and witnesses available. 

5. Upload the form into your Cake profile

Once you have completed your surrogate health care form and have all necessary signatures, it should be accessible to your surrogate and to anyone else you want. First, upload the document into your Cake profile and grant access to your surrogate. Next, make sure that all health care entities and your primary care physician have a copy so that your surrogate can perform their duties when necessary.

6. Review annually

Reviewing your surrogate health care form annually allows you to evaluate any changes to your health condition and check in with your surrogate. Your wishes may change over time, and you will want to enable your surrogate to state if they are still willing to assume the role. Your health care surrogate’s situation may change as well, and you may have to choose someone else. If your end-of-life wishes change, rewrite your advance directives to reflect your current thinking.

Having a Health Care Surrogate is Critical

Designating a health care surrogate is a critical part of advance planning. Anyone over the age of 18 should have a health care surrogate and the process of deciding on medical interventions is challenging but necessary. Take your time and select a trustworthy person to be your health care surrogate.

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